pvacanti
Networker
Having some discussions in the office about coding staged Hypospadias surgeries. Below is the op note of the 1st stage Hypospadias and would like suggestions for codes. I will post the 2nd stage Hypospadias op note next
PREOPERATIVE DIAGNOSIS Scrotal hypospadias.
POSTOPERATIVE DIAGNOSIS
Scrotal hypospadias.
PROCEDURE
1. Excision of scar for penile straightening.
2. Perineal urethrostomy.
3. Complex catheterization.
4. Dartos flap.
5. Byars flaps.
OPERATIVE DETAILS
ANESTHESIA: General plus caudal.
ESTIMATED BLOOD LOSS: 5 mL.
SPECIMENS: None.
DRAINS: 6-French urethral catheter.
DISPOSITION: Stable to postanesthesia care unit.
FINDINGS
1. Mid scrotal hypospadias, which did not move a significant distance distally following mobilization of the urethra and straightening of the penis.
2. 90 degrees of ventral penile curvature following mobilization of the urethra.
3. Straight phallus following creation of 3 ventral corporotomies.
INDICATIONS FOR PROCEDURE
The patient is a 6-month-old male with a history of a proximal hypospadias. Family wished surgical correction via a planned staged repair. Therefore, today the patient presented for the aforementioned procedure.
DESCRIPTION OF PROCEDURE
After the appropriate legal consent was obtained, the patient was brought to the main OR at Helen DeVos Children's Hospital. He was placed in supine position on the
operating room table. General as well as caudal anesthetic was administered per Anesthesiology Service. The patient's genitals were then prepped and draped in standard sterile fashion. A traction suture was then placed in the glans penis as well as each edge of the incomplete prepuce. Inspection of the
patient's phallus was noted to have a bifid scrotum with a mid scrotal hypospadiac meatus and greater than 90 degrees of ventral penile curvature. A Y-shaped incision was then marked extending up the ventrum of the penis on either side of the urethra and along the each edge of the incomplete prepuce. The incision was then marked around the meatus and proximally along the bifid scrotum in order to maximal position of urethra. The area for incision was then infiltrated with dilute epinephrine and cut. The ventrum of the penis was then degloved and the urethra was isolated as proximally as possible. The urethral plate was then mobilized off the urethra as proximally and distally as possible as well.
Artificial erection was administered. The patient was noted to have clear tethering of the penis by the urethra. Therefore, urethral plate was then transected as distally as possible. Repeat artificial erection revealed persistent 90 degree ventral penile curvature. Three ventral corporotomies were then created through the area of maximal curvature. Following completion of 3 corporotomies, significant ventral length was gained and the penis was straight. The urethra was then resecured to the penis using absorbable suture in interrupted fashion. Care was taken to avoid creation of any excess ventral tension by the urethra.
With the urethral meatus sitting at its natural position in the mid scrotum, attention was then turned toward the coverage of the corporotomies. Dartos flaps were rotated from the dorsum to the ventrum and secured over the corporotomies using absorbable suture in interrupted the fashion. With the dartos flap then in place, the Byars flaps were then rotated ventrally to cover the ventral skin defect. The perineal urethrostomy was then matured in the mid scrotum. The inner prepuce was approximated using absorbable suture in interrupted fashion. The inner prepuce was then approximated and interposing layer of dartos tissue was advanced using absorbable suture in interrupted fashion as well. The external prepuce was then closed along with the ventral penile shaft. This was closed using absorbable suture in interrupted fashion. The scrotum was then closed using absorbable suture in interrupted fashion as well. Throughout the case, meticulous hemostasis was achieved via electrocautery. A 6-French urethral was then placed and secured in place. Standard dressings were applied. The patient tolerated the procedure without apparent complication. He was taken in stable condition to postanesthesia care unit for brief postoperative convalescence prior to his anticipated discharge home
PREOPERATIVE DIAGNOSIS Scrotal hypospadias.
POSTOPERATIVE DIAGNOSIS
Scrotal hypospadias.
PROCEDURE
1. Excision of scar for penile straightening.
2. Perineal urethrostomy.
3. Complex catheterization.
4. Dartos flap.
5. Byars flaps.
OPERATIVE DETAILS
ANESTHESIA: General plus caudal.
ESTIMATED BLOOD LOSS: 5 mL.
SPECIMENS: None.
DRAINS: 6-French urethral catheter.
DISPOSITION: Stable to postanesthesia care unit.
FINDINGS
1. Mid scrotal hypospadias, which did not move a significant distance distally following mobilization of the urethra and straightening of the penis.
2. 90 degrees of ventral penile curvature following mobilization of the urethra.
3. Straight phallus following creation of 3 ventral corporotomies.
INDICATIONS FOR PROCEDURE
The patient is a 6-month-old male with a history of a proximal hypospadias. Family wished surgical correction via a planned staged repair. Therefore, today the patient presented for the aforementioned procedure.
DESCRIPTION OF PROCEDURE
After the appropriate legal consent was obtained, the patient was brought to the main OR at Helen DeVos Children's Hospital. He was placed in supine position on the
operating room table. General as well as caudal anesthetic was administered per Anesthesiology Service. The patient's genitals were then prepped and draped in standard sterile fashion. A traction suture was then placed in the glans penis as well as each edge of the incomplete prepuce. Inspection of the
patient's phallus was noted to have a bifid scrotum with a mid scrotal hypospadiac meatus and greater than 90 degrees of ventral penile curvature. A Y-shaped incision was then marked extending up the ventrum of the penis on either side of the urethra and along the each edge of the incomplete prepuce. The incision was then marked around the meatus and proximally along the bifid scrotum in order to maximal position of urethra. The area for incision was then infiltrated with dilute epinephrine and cut. The ventrum of the penis was then degloved and the urethra was isolated as proximally as possible. The urethral plate was then mobilized off the urethra as proximally and distally as possible as well.
Artificial erection was administered. The patient was noted to have clear tethering of the penis by the urethra. Therefore, urethral plate was then transected as distally as possible. Repeat artificial erection revealed persistent 90 degree ventral penile curvature. Three ventral corporotomies were then created through the area of maximal curvature. Following completion of 3 corporotomies, significant ventral length was gained and the penis was straight. The urethra was then resecured to the penis using absorbable suture in interrupted fashion. Care was taken to avoid creation of any excess ventral tension by the urethra.
With the urethral meatus sitting at its natural position in the mid scrotum, attention was then turned toward the coverage of the corporotomies. Dartos flaps were rotated from the dorsum to the ventrum and secured over the corporotomies using absorbable suture in interrupted the fashion. With the dartos flap then in place, the Byars flaps were then rotated ventrally to cover the ventral skin defect. The perineal urethrostomy was then matured in the mid scrotum. The inner prepuce was approximated using absorbable suture in interrupted fashion. The inner prepuce was then approximated and interposing layer of dartos tissue was advanced using absorbable suture in interrupted fashion as well. The external prepuce was then closed along with the ventral penile shaft. This was closed using absorbable suture in interrupted fashion. The scrotum was then closed using absorbable suture in interrupted fashion as well. Throughout the case, meticulous hemostasis was achieved via electrocautery. A 6-French urethral was then placed and secured in place. Standard dressings were applied. The patient tolerated the procedure without apparent complication. He was taken in stable condition to postanesthesia care unit for brief postoperative convalescence prior to his anticipated discharge home
